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Farmácia Popular Program: changes in geographic accessibility of medicines during ten years of a medicine subsidy policy in Brazil.

Emmerick IC, do Nascimento JM, Pereira MA, Luiza VL, Ross-Degnan D, ISAUM-Br Collaborative Gro - J Pharm Policy Pract (2015)

Bottom Line: Specifically, the wealthy areas in the South and Southeast have higher coverage, with lower coverage mostly in the North and Northeast, relatively poorer areas with greater need for access to medicines, health care, and other basic services such as potable water and sanitization.This has led to greater program coverage and has potentially improved access to FPP medicines in the country.Nevertheless, disparities in pharmacy coverage remain among the regions.

View Article: PubMed Central - PubMed

Affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215 USA ; Nucleus for Pharmaceutical Policies, National School of Public Health, Oswaldo Cruz Foundation, 1480, Rua Leopoldo Bulhões # 624, Manguinhos, 21021-000 Rio de Janeiro, RJ Brazil.

ABSTRACT

Objectives: The Brazilian constitution guarantees the right to health, including access to medicines. In May 2004, Brazil's government announced the "Farmácia Popular" Program (FPP) as a new mechanism to improve the Brazilian population's access to medicines. Under FPP, a selected list of medicines is subsidized by the government and provided in public and private pharmacies. The aim of this study is to describe the historical stages of the FPP and to identify associated changes in the geographical accessibility of medicines through the FPP over time.

Methods: It was performed documentary review and an ecological study assessing program coverage in terms of number of facilities and a FPP Pharmacy Facilities Density (PFD) index at national and regional levels from 2004 to 2013, using the FPP database. We used geographic information system mapping to depict a pharmaceutical facilities density (PFD) index at the municipality level on thematic maps.

Results: A growth of the PFD index coincident with the phases of the FPP was noticed. In the public sector, the program started in 2004; by 2006, there was a sharp increase in the numbers of participating pharmacies, stabilizing in 2009. In the private sector, the program started in 2006; by 2009 the PFD ratio had increased substantially and it continued to grow through 2011. There was an increase in FPP coverage in most regions between 2006, when the private pharmacy component started, and 2013, but participating pharmacies remain unequally distributed across geographical regions. Specifically, the wealthy areas in the South and Southeast have higher coverage, with lower coverage mostly in the North and Northeast, relatively poorer areas with greater need for access to medicines, health care, and other basic services such as potable water and sanitization.

Conclusions: There has been a substantial increase in the number of pharmacies participating in the FPP over time. This has led to greater program coverage and has potentially improved access to FPP medicines in the country. Nevertheless, disparities in pharmacy coverage remain among the regions.

No MeSH data available.


Related in: MedlinePlus

Time line of the"Farmácia Popular"Program. A–FPP (May 2004): “Programa Farmácia Popular do Brasil”-Brazilian Popular Pharmacy Program-Initiation of “Farmácia Popular rede própria”. B–AFP I (March 2006): “Aqui tem farmácia Popular”–Popular Pharmacy is Available Here–Phase I–Private Sector–public private partnership. C–AFP II (April 2009): “Aqui tem farmácia Popular”-Popular Pharmacy is Available Here–Phase II. After changes on administrative procedures and on medicines covered. D–SNP (February 2011): “Saúde não tem preço”-Health has no price. Free of Charge medicines for Hypertension and Diabetes.
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Fig1: Time line of the"Farmácia Popular"Program. A–FPP (May 2004): “Programa Farmácia Popular do Brasil”-Brazilian Popular Pharmacy Program-Initiation of “Farmácia Popular rede própria”. B–AFP I (March 2006): “Aqui tem farmácia Popular”–Popular Pharmacy is Available Here–Phase I–Private Sector–public private partnership. C–AFP II (April 2009): “Aqui tem farmácia Popular”-Popular Pharmacy is Available Here–Phase II. After changes on administrative procedures and on medicines covered. D–SNP (February 2011): “Saúde não tem preço”-Health has no price. Free of Charge medicines for Hypertension and Diabetes.

Mentions: The “Farmácia Popular” Program (FPP) was created in 2004 and during the succeeding 10 years the FPP experienced three main changes (Figure 1). In 2006, the government expanded the program to the private retail pharmacies; in 2009 the medicines list (Additional file 2) was expanded and some administrative requirements changed; and in 2011, medicines for diabetes and hypertension started to be fully subsidized. The medicines list covered also changed over time, becoming broader and covering more diseases. Three modalities of "Farmácia Popular" are concurrently in place at this time: FPP in public facilities; AFP in accredited private retail pharmacies; and SNP which covers a subset of medicines targeting relevant chronic diseases that are dispensed to patients with no co-payment in both the FPP and AFP. These modalities are described below.Figure 1


Farmácia Popular Program: changes in geographic accessibility of medicines during ten years of a medicine subsidy policy in Brazil.

Emmerick IC, do Nascimento JM, Pereira MA, Luiza VL, Ross-Degnan D, ISAUM-Br Collaborative Gro - J Pharm Policy Pract (2015)

Time line of the"Farmácia Popular"Program. A–FPP (May 2004): “Programa Farmácia Popular do Brasil”-Brazilian Popular Pharmacy Program-Initiation of “Farmácia Popular rede própria”. B–AFP I (March 2006): “Aqui tem farmácia Popular”–Popular Pharmacy is Available Here–Phase I–Private Sector–public private partnership. C–AFP II (April 2009): “Aqui tem farmácia Popular”-Popular Pharmacy is Available Here–Phase II. After changes on administrative procedures and on medicines covered. D–SNP (February 2011): “Saúde não tem preço”-Health has no price. Free of Charge medicines for Hypertension and Diabetes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4403833&req=5

Fig1: Time line of the"Farmácia Popular"Program. A–FPP (May 2004): “Programa Farmácia Popular do Brasil”-Brazilian Popular Pharmacy Program-Initiation of “Farmácia Popular rede própria”. B–AFP I (March 2006): “Aqui tem farmácia Popular”–Popular Pharmacy is Available Here–Phase I–Private Sector–public private partnership. C–AFP II (April 2009): “Aqui tem farmácia Popular”-Popular Pharmacy is Available Here–Phase II. After changes on administrative procedures and on medicines covered. D–SNP (February 2011): “Saúde não tem preço”-Health has no price. Free of Charge medicines for Hypertension and Diabetes.
Mentions: The “Farmácia Popular” Program (FPP) was created in 2004 and during the succeeding 10 years the FPP experienced three main changes (Figure 1). In 2006, the government expanded the program to the private retail pharmacies; in 2009 the medicines list (Additional file 2) was expanded and some administrative requirements changed; and in 2011, medicines for diabetes and hypertension started to be fully subsidized. The medicines list covered also changed over time, becoming broader and covering more diseases. Three modalities of "Farmácia Popular" are concurrently in place at this time: FPP in public facilities; AFP in accredited private retail pharmacies; and SNP which covers a subset of medicines targeting relevant chronic diseases that are dispensed to patients with no co-payment in both the FPP and AFP. These modalities are described below.Figure 1

Bottom Line: Specifically, the wealthy areas in the South and Southeast have higher coverage, with lower coverage mostly in the North and Northeast, relatively poorer areas with greater need for access to medicines, health care, and other basic services such as potable water and sanitization.This has led to greater program coverage and has potentially improved access to FPP medicines in the country.Nevertheless, disparities in pharmacy coverage remain among the regions.

View Article: PubMed Central - PubMed

Affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215 USA ; Nucleus for Pharmaceutical Policies, National School of Public Health, Oswaldo Cruz Foundation, 1480, Rua Leopoldo Bulhões # 624, Manguinhos, 21021-000 Rio de Janeiro, RJ Brazil.

ABSTRACT

Objectives: The Brazilian constitution guarantees the right to health, including access to medicines. In May 2004, Brazil's government announced the "Farmácia Popular" Program (FPP) as a new mechanism to improve the Brazilian population's access to medicines. Under FPP, a selected list of medicines is subsidized by the government and provided in public and private pharmacies. The aim of this study is to describe the historical stages of the FPP and to identify associated changes in the geographical accessibility of medicines through the FPP over time.

Methods: It was performed documentary review and an ecological study assessing program coverage in terms of number of facilities and a FPP Pharmacy Facilities Density (PFD) index at national and regional levels from 2004 to 2013, using the FPP database. We used geographic information system mapping to depict a pharmaceutical facilities density (PFD) index at the municipality level on thematic maps.

Results: A growth of the PFD index coincident with the phases of the FPP was noticed. In the public sector, the program started in 2004; by 2006, there was a sharp increase in the numbers of participating pharmacies, stabilizing in 2009. In the private sector, the program started in 2006; by 2009 the PFD ratio had increased substantially and it continued to grow through 2011. There was an increase in FPP coverage in most regions between 2006, when the private pharmacy component started, and 2013, but participating pharmacies remain unequally distributed across geographical regions. Specifically, the wealthy areas in the South and Southeast have higher coverage, with lower coverage mostly in the North and Northeast, relatively poorer areas with greater need for access to medicines, health care, and other basic services such as potable water and sanitization.

Conclusions: There has been a substantial increase in the number of pharmacies participating in the FPP over time. This has led to greater program coverage and has potentially improved access to FPP medicines in the country. Nevertheless, disparities in pharmacy coverage remain among the regions.

No MeSH data available.


Related in: MedlinePlus